In view of the recent reported surge in respiratory illness especially in children in northern China in the recent weeks, Additional Chief Secretary, Health, Arun Kumar Singh has written to all Deputy Commissioners stating that there is an urgent need to keep on constant vigil, monitor trends of cases and quick response to any emerging public health threat. All districts and health facilities need to proactively review the preparedness measures against respiratory illnesses, as a cautionary measure.

Due to continuous surge of childhood pneumonia, in view of the ongoing influenza and winter season there might be an increase in respiratory illness cases. This is predominantly attributed to usual causes like influenza strain (H1N1/H3N2/H5N1/H9N2 etc.), mycoplasma pneumonia, SARS-CoV-2 etc. In order to minimize the incidence of respiratory diseases along with current scenario of unusual causes of respiratory diseases in Children or any unexpected clinical manifestations, there is need to increase the surveillance and remain vigilant and to monitor the continuously changing nature of the virus including respiratory pathogen (H1N1, H3N2 etc and evolution of SARS CoV-2 variants.

The Additional CS has said that in order to limit transmission of these respiratory pathogens, several public health actions are advisable, which are the following.

1. To strengthen the Flu/Respiratory clinic in the OPD/IPD of Medical colleges, District Hospital, SDH and CHC for testing of symptomatic ILI/SARI Cases. To test the healthcare workers, co- morbid and other vulnerable population for enhancing the testing and timely detection of respiratory pathogen. Dept of Microbiology, RIMS and MGM, MC, Jamshedpur are sentinel sites for sending the suspected samples from HCFs.

2. To ensure to raise community awareness regarding adherence to respiratory etiquettes and hand hygiene (like covering one's mouth and nose with a tissue/elbow when coughing or sneezing, avoiding spitting in public places, preferably use of mask in crowded environment, frequent hand wash etc), prompt reporting and limiting contact with people who are suffering from respiratory illness.

3. To ensure monitoring and reporting of district wise Influenza like illness (ILI) and Severe Acute Respiratory Illness (SARI) cases in all health facilities including medical colleges on regular basis for detecting the early rising trends of cases along with data upload in the IDSP-IHIP portal. Trends of IL/SARI to be closely monitored by District Surveillance Officer.

4. It should also be ensured that the health facilities including Private facilities and medical college hospitals, report all cases of ILI and SARI on IDSP-IHIP at District Surveillance Unit,

5. For the surveillance perspective, District administration shall ensure to monitor the implementation of "Operational Guidelines for Revised Surveillance Strategy in context of COVID- 19, annexed along with this letter.

6. To ensure preparedness by reviewing the existing hospital capacities including paediatric ward, NICU, PICU with regards to bed availability including Oxygen supported beds, ICU beds, logistic requirements like human resources, equipments, testing kits & reagents, PPE, drugs, antibiotics and consumables as well as re-orientation of health care workers in working in the hospitals. This may be tested by conducting 'dry runs' in hospitals. . To ensure proper functioning of medical oxygen equipment like 02 Cylinders, Flowmeters, 02 7 Concentrators, Ventilators, LMO plants, PSA plants, oxygen pipelines etc. by following measures:

a. Assess availability of Liquid Medical Oxygen (LMO) in the health facilities and uninterrupted supply chain for their refilling.

b. To monitor the supply and installation of LMO-10 KL with MGPS in 19 District Hospitals and 6 Medical Colleges under ECRP-2, updated work progress report has been shared vide letter no idsp/ECRP-II/LMO tank/66/2022-528(MD), dated 10.11.2023 for your needful action.

c. Ensure adequate inventory of 02 Cylinders with backup stocks and refilling systems along with functionality of all available 02 Concentrators, Ventilators, BIPAP machines, SpO system etc. d. To ensure functional PSA plants by conducting regular mock drills.

PAN India Mock drill exercise across all health facilities on 24th November was conducted in your respective districts under the overall guidance of your able leadership to ensure operational readiness of medical oxygen infrastructure preparedness in case of oxygen demand increases in future and corrective measures to be taken for non-functionality of any Bio-medical equipment. I am sure that under your able leadership, districts shall take proactive actions in this regard and undertake requisite public health measures on this evolving situation to minimize any spread.